In the Women's Health Initiative (WHI), postmenopausal women receiving combination hormone therapy (HT) experienced more adverse outcomes than placebo recipients. To determine whether gynecologists and internists interpreted the WHI differently, we conducted a survey in which physicians responded to a hypothetical asymptomatic woman who asks whether to continue HT. In response to this scenario, gynecologists were more likely than internists to hold permissive views about prescribing HT (66% vs 35%; P<.001). These results suggest that gynecologists may be less concerned than internists about the adverse events associated with HT, or that gynecologists have stronger beliefs about benefits of HT.

This propensity score matching analysis confirms that pelvic pain and AUB are common in women before and after sterilization regardless of whether the procedure is performed hysteroscopically or laparoscopically. Moreover, HS is associated with a significantly lower risk of hysterectomy or a CPP diagnosis in the 24months poststerilization when compared to TL.

Among commercially insured women in the United States, HS versus LBTL is associated with lower average costs for the index procedure and lower total healthcare and procedure-related costs during 6 months after the sterilization procedure.

The objectives were to compare the long-term outcomes, including hysterectomy, chronic pelvic pain (CPP) and abnormal uterine bleeding (AUB), in women post hysteroscopic sterilization (HS) and laparoscopic tubal ligation (TL) in the Medicaid population. Study design: This was a retrospective observational cohort analysis using data from the US Medicaid Analytic Extracts Encounters database. Women aged 18 to 49 years with at least one claim for HS (=3929) or TL (= n n 10,875) between July 1, 2009, through December 31, 2010, were included. Main outcome measures were hysterectomy, CPP or AUB in the 24 months poststerilization. Propensity score matching was used to control for patient demographics and baseline characteristics. Logistic regression analysis investigated the variables associated with a 24-month rate of each outcome in the HS versus laparoscopic TL cohorts. Results: Postmatching analyses were performed at 6, 12 and 24 months post index procedure. At 24 months, hysterectomy was more common in the laparoscopic TL than the HS group (3.5% vs. 2.1%; p=.0023), as was diagnosis of CPP (26.8% vs. 23.5%; p=.0050). No significant differences in AUB diagnoses were observed. Logistic regression identi ed HS as being associated with lower risk of hysterectomy (odds ratio [OR] 0.77 [95% fi confidence interval {CI} 0.60-0.97]; p=.0274) and lower risk of CPP diagnosis (OR 0.91 [95% CI 0.83-0.99]; p= .0336) at 24 months poststerilization. Conclusion: In Medicaid patients, HS is associated with a significantly lower risk of hysterectomy or CPP diagnosis 24 months poststerilization versus laparoscopic TL. Incidence of AUB poststerilization is not significantly different. While some differences in outcomes were statistically signi cant, the effect sizes were small, and the fi conclusion is one of equivalence and not clinical superiority. Implications statement: This propensity score matching analysis confirms that pelvic pain and AUB are common in women before and after sterilization regardless of whether the procedure is performed hysteroscopically or laparoscopically. Moreover, HS is associated with a signi cantly lower risk of hysterectomy or a CPP diagnosis fi in the 24 months poststerilization when compared to TL.